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Yoon DW, Kang D, Jeon YJ, Lee J, Shin S, Cho JH, Choi YS, Zo JI, Kim J, Shim YM, Cho J, Kim HK, Lee HY. Computed tomography characteristics of cN0 primary non-small cell lung cancer predict occult lymph node metastasis. Eur Radiol 2024:10.1007/s00330-024-10835-z. [PMID: 38850308 DOI: 10.1007/s00330-024-10835-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 04/23/2024] [Accepted: 05/10/2024] [Indexed: 06/10/2024]
Abstract
RATIONALE Occult lymph node metastasis (OLNM) is frequently found in patients with resectable non-small cell lung cancer (NSCLC), despite using diagnostic methods recommended by guidelines. OBJECTIVES To evaluate the risk of OLNM in NSCLC patients using the radiologic characteristics of the primary tumor on computed tomography (CT). METHODS We retrospectively reviewed clinicopathologic features of 2042 clinical T1-4N0 NSCLC patients undergoing curative intent pulmonary resection. Unique radiological features (i.e., air-bronchogram throughout the whole tumor, heterogeneous ground-glass opacity (GGO), mainly cystic appearance, endobronchial location), percentage of solid portion, and shape of tumor margin were analyzed via a stepwise approach. We used multivariable logistic regression to assess the relationship between OLNM and tumor characteristics. RESULTS Compared with the other unique features, endobronchial tumors were associated with the highest risk of OLNM (OR = 3.9, 95% confidence interval (CI) = 2.29-6.62), and heterogeneous GGO and mainly cystic tumors were associated with a low risk of OLNM. For tumors without unique features, the percentage of the solid portion was measured, and solid tumors were associated with OLNM (OR = 2.49, 95% CI = 1.86-3.35). Among part-solid tumors with solid proportion > 50%, spiculated margin, and peri-tumoral GGO were associated with OLNM. CONCLUSIONS The risk of OLNM could be assessed using radiologic characteristics on CT. This could allow us to adequately select optimal candidates for invasive nodal staging procedures (INSPs) and complete systematic lymph node dissection. CLINICAL RELEVANCE STATEMENT These data may be helpful for clinicians to select appropriate candidates for INSPs and complete surgical systematic lymph node dissection in NSCLC patients. KEY POINTS Lymph node metastasis status plays a key role in both prognostication and treatment planning. Solid tumors, particularly endobronchial tumors, were associated with occult lymph node metastasis (OLNM). The risk of OLNM can be assessed using radiologic characteristics acquired from CT images.
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Affiliation(s)
- Dong Woog Yoon
- Department of Thoracic and Cardiovascular Surgery, Chungang-University Hospital, Seoul, South Korea
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea
| | - Yeong Jeong Jeon
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Junghee Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Ill Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea
- Departments of Epidemiology and Health, Behavior, and Society, Baltimore, MD, USA
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ho Yun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea.
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Huang M, Liu B, Li X, Li N, Yang X, Wang Y, Zhang S, Lu F, Li S, Yan S, Wu N. Beneficial implications of adjuvant chemotherapy for stage IB lung adenocarcinoma exhibiting elevated SUVmax in FDG-PET/CT: a retrospective study from a single center. Front Oncol 2024; 14:1367200. [PMID: 38529383 PMCID: PMC10961360 DOI: 10.3389/fonc.2024.1367200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/26/2024] [Indexed: 03/27/2024] Open
Abstract
Background Controversy surrounds the efficacy of adjuvant chemotherapy (ACT) in the treatment of stage I lung adenocarcinoma (LUAD). The objective of this study was to examine the impact of the maximum standardized uptake value (SUVmax) as measured by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) on the efficacy of ACT in patients diagnosed with stage I LUAD. Methods We scrutinized the medical records of 928 consecutive patients who underwent complete surgical resection for pathological stage I LUAD at our institution. The ideal cut-off value for primary tumor SUVmax in terms of disease-free survival (DFS) and overall survival (OS) was determined using the X-tile software. The Kaplan-Meier method and Cox regression analysis were used for survival analysis. Results Based on the SUVmax algorithm, the ideal cutoff values were determined to be 4.9 for DFS and 5.0 for OS. We selected 5.0 as the threshold because OS is the more widely accepted predictive endpoint. In a multivariate Cox regression analysis, SUVmax ≥ 5.0, problematic IB stage, and sublobectomy were identified as independent risk factors for poor DFS and OS. It is noteworthy that patients who were administered ACT had significantly longer DFS and OS than what was observed in the subgroup of patients with pathological stage IB LUAD and SUVmax ≥ 5.0 (p < 0.035 and p ≤ 0.046, respectively). However, there was no observed survival advantage for patients in stages IA or IB who had an SUVmax < 5.0. Conclusion The preoperative SUVmax of tumors served as an indicator of the impact of ACT in the context of completely resected pathological stage I LUAD. Notably, patients within the Stage IB category exhibiting elevated SUVmax levels emerged as a subgroup experiencing substantial benefits from postoperative ACT.
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Affiliation(s)
- Miao Huang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing, China
| | - Bing Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiang Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing, China
| | - Nan Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xin Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yaqi Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing, China
| | - Shanyuan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing, China
| | - Fangliang Lu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing, China
| | - Shaolei Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing, China
| | - Shi Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing, China
| | - Nan Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing, China
- State Key Laboratory of Molecular Oncology, Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing, China
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Hamada A, Kitajima K, Suda K, Koga T, Soh J, Kaida H, Ito K, Sekine T, Takegahara K, Daisaki H, Hashimoto M, Yoshida Y, Kabasawa T, Yamasaki T, Hirota S, Usuda J, Ishii K, Mitsudomi T. Prognostic role of preoperative fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography with an image-based harmonization technique: A multicenter retrospective study. JTCVS OPEN 2023; 14:502-522. [PMID: 37425462 PMCID: PMC10328817 DOI: 10.1016/j.xjon.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 07/11/2023]
Abstract
Objectives Despite the prognostic impacts of preoperative fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography examination, fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography-based prognosis prediction has not been used clinically because of the disparity in data between institutions. By applying an image-based harmonized approach, we evaluated the prognostic roles of fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography parameters in clinical stage I non-small cell lung cancer. Methods We retrospectively examined 495 patients with clinical stage I non-small cell lung cancer who underwent fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography examinations before pulmonary resection between 2013 and 2014 at 4 institutions. Three different harmonization techniques were applied, and an image-based harmonization, which showed the best-fit results, was used in the further analyses to evaluate the prognostic roles of fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography parameters. Results Cutoff values of image-based harmonized fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography parameters, maximum standardized uptake, metabolic tumor volume, and total lesion glycolysis were determined using receiver operating characteristic curves that distinguish pathologic high invasiveness of tumors. Among these parameters, only the maximum standardized uptake was an independent prognostic factor in recurrence-free and overall survivals in univariate and multivariate analyses. High image-based maximum standardized uptake value was associated with squamous histology or lung adenocarcinomas with higher pathologic grades. In subgroup analyses defined by ground-glass opacity status and histology or by clinical stages, the prognostic impact of image-based maximum standardized uptake value was always the highest compared with other fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography parameters. Conclusions The image-based fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography harmonization was the best fit, and the image-based maximum standardized uptake was the most important prognostic marker in all patients and in subgroups defined by ground-glass opacity status and histology in surgically resected clinical stage I non-small cell lung cancers.
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Affiliation(s)
- Akira Hamada
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Kazuhiro Kitajima
- Department of Radiology, Hyogo Medical University School of Medicine, Hyogo, Japan
| | - Kenichi Suda
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Takamasa Koga
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Junichi Soh
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Hayato Kaida
- Department of Radiology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Kimiteru Ito
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Tetsuro Sekine
- Department of Radiology, Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Japan
| | - Kyoshiro Takegahara
- Department of Thoracic Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Hiromitsu Daisaki
- Department of Radiological Technology, School of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Japan
| | - Masaki Hashimoto
- Departments of Thoracic Surgery and Orthopedic Surgery, Hyogo Medical University School of Medicine, Hyogo, Japan
| | - Yukihiro Yoshida
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Takanobu Kabasawa
- Department of Pathological Diagnostics, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Takashi Yamasaki
- Department of Surgical Pathology, Hyogo Medical University School of Medicine, Hyogo, Japan
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo Medical University School of Medicine, Hyogo, Japan
| | - Jitsuo Usuda
- Department of Thoracic Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Kazunari Ishii
- Department of Radiology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Tetsuya Mitsudomi
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
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Kamigaichi A, Mimae T, Tsubokawa N, Miyata Y, Adachi H, Shimada Y, Ito H, Ikeda N, Okada M. Wedge resection is an acceptable treatment option for radiologically low-grade lung cancer with solid predominance. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 36:6978240. [PMID: 36802259 PMCID: PMC9931075 DOI: 10.1093/icvts/ivac285] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/23/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES This study aimed to determine the clinical characteristics for predicting low-grade cancer in radiologically solid predominant non-small-cell lung cancer (NSCLC) and compare the survival outcomes of wedge resection with those of anatomical resection for patients with and without these characteristics. METHODS Consecutive patients with clinical stages IA1-IA2 NSCLC showing radiologically solid predominance ≤2 cm at 3 institutions were retrospectively evaluated. Low-grade cancer was defined as the absence of nodal involvement and blood vessel, lymphatic and pleural invasion. The predictive criteria for low-grade cancer were established by multivariable analysis. The prognosis of wedge resection was compared with that of anatomical resection for patients who met the criteria, using the propensity score-matched analysis. RESULTS Among 669 patients, multivariable analysis showed that ground-glass opacity (GGO) (P < 0.001) on thin-section computed tomography and an increased maximum standardized uptake value on 18-fluoro-2-deoxyglucose positron emission tomography/computed tomography (P < 0.001) were independent predictors of low-grade cancer. The predictive criteria were defined as GGO presence and maximum standardized uptake value ≤1.1 (specificity: 97.8%, sensitivity: 21.4%). In the propensity score-matched pairs (n = 189), overall survival (P = 0.41) and relapse-free survival (P = 0.18) were not significantly different between patients who underwent wedge resection and anatomical resection among those who fulfilled the criteria. CONCLUSIONS The radiologic criteria for GGO and a low maximum standardized uptake value could predict low-grade cancer, even in solid-dominant NSCLC sized ≤2 cm. Wedge resection could be an acceptable surgical option for patients with radiologically predicted indolent NSCLC showing a solid-dominant appearance.
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Affiliation(s)
| | - Takahiro Mimae
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | | | - Yoshihiro Miyata
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Hiroyuki Adachi
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | | | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Morihito Okada
- Corresponding author. Department of Surgical Oncology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan. Tel: +81-82-257-5869; fax: +81-82-256-7109; e-mail: (M. Okada)
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Nam JG, Park S, Park CM, Jeon YK, Chung DH, Goo JM, Kim YT, Kim H. Histopathologic Basis for a Chest CT Deep Learning Survival Prediction Model in Patients with Lung Adenocarcinoma. Radiology 2022; 305:441-451. [PMID: 35787198 DOI: 10.1148/radiol.213262] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background A preoperative CT-based deep learning (DL) prediction model was proposed to estimate disease-free survival in patients with resected lung adenocarcinoma. However, the black-box nature of DL hinders interpretation of its results. Purpose To provide histopathologic evidence underpinning the DL survival prediction model and to demonstrate the feasibility of the model in identifying patients with histopathologic risk factors through unsupervised clustering and a series of regression analyses. Materials and Methods For this retrospective study, data from patients who underwent curative resection for lung adenocarcinoma without neoadjuvant therapy from January 2016 to September 2020 were collected from a tertiary care center. Seven histopathologic risk factors for the resected adenocarcinoma were documented: the aggressive adenocarcinoma subtype (cribriform, morular, solid, or micropapillary-predominant subtype); mediastinal nodal metastasis (pN2); presence of lymphatic, venous, and perineural invasion; visceral pleural invasion (VPI); and EGFR mutation status. Unsupervised clustering using 80 DL model-driven CT features was performed, and associations between the patient clusters and the histopathologic features were analyzed. Multivariable regression analyses were performed to investigate the added value of the DL model output to the semantic CT features (clinical T category and radiologic nodule type [ie, solid or subsolid]) for histopathologic associations. Results A total of 1667 patients (median age, 64 years [IQR, 57-71 years]; 975 women) were evaluated. Unsupervised patient clusters 3 and 4 were associated with all histopathologic risk factors (P < .01) except for EGFR mutation status (P = .30 for cluster 3). After multivariable adjustment, model output was associated with the aggressive adenocarcinoma subtype (odds ratio [OR], 1.03; 95% CI: 1.002, 1.05; P = .03), venous invasion (OR, 1.03; 95% CI: 1.004, 1.06; P = .02), and VPI (OR, 1.08; 95% CI: 1.06, 1.10; P < .001), independently of the semantic CT features. Conclusion The deep learning model extracted CT imaging surrogates for the histopathologic profiles of lung adenocarcinoma. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Yanagawa in this issue.
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Affiliation(s)
- Ju G Nam
- From the Department of Radiology (J.G.N., C.M.P., J.M.G., H.K.), Department of Thoracic and Cardiovascular Surgery (S.P., Y.T.K.), and Department of Pathology (Y.K.J., D.H.C.), Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Artificial Intelligence Collaborative Network, Seoul National University Hospital, Seoul, Republic of Korea (J.G.N.); Institute of Radiation Medicine (C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (Y.K.J., J.M.G., Y.T.K.)
| | - Samina Park
- From the Department of Radiology (J.G.N., C.M.P., J.M.G., H.K.), Department of Thoracic and Cardiovascular Surgery (S.P., Y.T.K.), and Department of Pathology (Y.K.J., D.H.C.), Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Artificial Intelligence Collaborative Network, Seoul National University Hospital, Seoul, Republic of Korea (J.G.N.); Institute of Radiation Medicine (C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (Y.K.J., J.M.G., Y.T.K.)
| | - Chang Min Park
- From the Department of Radiology (J.G.N., C.M.P., J.M.G., H.K.), Department of Thoracic and Cardiovascular Surgery (S.P., Y.T.K.), and Department of Pathology (Y.K.J., D.H.C.), Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Artificial Intelligence Collaborative Network, Seoul National University Hospital, Seoul, Republic of Korea (J.G.N.); Institute of Radiation Medicine (C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (Y.K.J., J.M.G., Y.T.K.)
| | - Yoon Kyung Jeon
- From the Department of Radiology (J.G.N., C.M.P., J.M.G., H.K.), Department of Thoracic and Cardiovascular Surgery (S.P., Y.T.K.), and Department of Pathology (Y.K.J., D.H.C.), Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Artificial Intelligence Collaborative Network, Seoul National University Hospital, Seoul, Republic of Korea (J.G.N.); Institute of Radiation Medicine (C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (Y.K.J., J.M.G., Y.T.K.)
| | - Doo Hyun Chung
- From the Department of Radiology (J.G.N., C.M.P., J.M.G., H.K.), Department of Thoracic and Cardiovascular Surgery (S.P., Y.T.K.), and Department of Pathology (Y.K.J., D.H.C.), Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Artificial Intelligence Collaborative Network, Seoul National University Hospital, Seoul, Republic of Korea (J.G.N.); Institute of Radiation Medicine (C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (Y.K.J., J.M.G., Y.T.K.)
| | - Jin Mo Goo
- From the Department of Radiology (J.G.N., C.M.P., J.M.G., H.K.), Department of Thoracic and Cardiovascular Surgery (S.P., Y.T.K.), and Department of Pathology (Y.K.J., D.H.C.), Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Artificial Intelligence Collaborative Network, Seoul National University Hospital, Seoul, Republic of Korea (J.G.N.); Institute of Radiation Medicine (C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (Y.K.J., J.M.G., Y.T.K.)
| | - Young Tae Kim
- From the Department of Radiology (J.G.N., C.M.P., J.M.G., H.K.), Department of Thoracic and Cardiovascular Surgery (S.P., Y.T.K.), and Department of Pathology (Y.K.J., D.H.C.), Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Artificial Intelligence Collaborative Network, Seoul National University Hospital, Seoul, Republic of Korea (J.G.N.); Institute of Radiation Medicine (C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (Y.K.J., J.M.G., Y.T.K.)
| | - Hyungjin Kim
- From the Department of Radiology (J.G.N., C.M.P., J.M.G., H.K.), Department of Thoracic and Cardiovascular Surgery (S.P., Y.T.K.), and Department of Pathology (Y.K.J., D.H.C.), Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Artificial Intelligence Collaborative Network, Seoul National University Hospital, Seoul, Republic of Korea (J.G.N.); Institute of Radiation Medicine (C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (Y.K.J., J.M.G., Y.T.K.)
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Zheng H, Yuan C, Cai J, Pu W, Wu P, Li C, Li G, Zhang Y, Zhang J, Guo J, Huang D. Early diagnosis of breast cancer lung metastasis by nanoprobe-based luminescence imaging of the pre-metastatic niche. J Nanobiotechnology 2022; 20:134. [PMID: 35292019 PMCID: PMC8922882 DOI: 10.1186/s12951-022-01346-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/02/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Early detection of breast cancer lung metastasis remains highly challenging, due to few metastatic cancer cells at an early stage. Herein we propose a new strategy for early diagnosis of lung metastasis of breast cancer by luminescence imaging of pulmonary neutrophil infiltration via self-illuminating nanoprobes. METHODS Luminescent nanoparticles (LAD NPs) were engineered using a biocompatible, neutrophil-responsive self-illuminating cyclodextrin material and an aggregation-induced emission agent. The chemiluminescence resonance energy transfer (CRET) effect and luminescence properties of LAD NPs were fully characterized. Using mouse peritoneal neutrophils, in vitro luminescence properties of LAD NPs were thoroughly examined. In vivo luminescence imaging and correlation analyses were performed in mice inoculated with 4T1 cancer cells. Moreover, an active targeting nanoprobe was developed by surface decoration of LAD NPs with a neutrophil-targeting peptide, which was also systemically evaluated by in vitro and in vivo studies. RESULTS LAD NPs can generate long-wavelength and persistent luminescence due to the CRET effect. In a mouse model of 4T1 breast cancer lung metastasis, we found desirable correlation between neutrophils and tumor cells in the lungs, demonstrating the effectiveness of early imaging of the pre-metastatic niche by the newly developed LAD NPs. The active targeting nanoprobe showed further enhanced luminescence imaging capability for early detection of pulmonary metastasis. Notably, the targeting nanoprobe-based luminescence imaging strategy remarkably outperformed PET/CT imaging modalities in the examined mouse model. Also, preliminary tests demonstrated good safety of LAD NPs. CONCLUSIONS The neutrophil-targeting imaging strategy based on newly developed luminescence nanoparticles can serve as a promising modality for early diagnosis of lung metastasis of breast cancers.
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Affiliation(s)
- Hanwen Zheng
- Department of Nuclear Medicine, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Main Street, Chongqing, 400038, China
- Department of Pharmaceutics, College of Pharmacy, Third Military Medical University (Army Medical University), 30 Gaotanyan Main Street, Chongqing, 400038, China
- Department of Pharmaceutical Analysis, College of Pharmacy, Third Military Medical University (Army Medical University), 30 Gaotanyan Main Street, Chongqing, 400038, China
| | - Chunsen Yuan
- Department of Nuclear Medicine, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Main Street, Chongqing, 400038, China
| | - Jiajun Cai
- Department of Pharmaceutics, College of Pharmacy, Third Military Medical University (Army Medical University), 30 Gaotanyan Main Street, Chongqing, 400038, China
| | - Wendan Pu
- Department of Pharmaceutics, College of Pharmacy, Third Military Medical University (Army Medical University), 30 Gaotanyan Main Street, Chongqing, 400038, China
| | - Peng Wu
- Department of Pharmaceutics, College of Pharmacy, Third Military Medical University (Army Medical University), 30 Gaotanyan Main Street, Chongqing, 400038, China
- College of Pharmacy and Medical Technology, Hanzhong Vocational and Technical College, Hanzhong, 723000, Shaanxi, China
| | - Chenwen Li
- Department of Pharmaceutics, College of Pharmacy, Third Military Medical University (Army Medical University), 30 Gaotanyan Main Street, Chongqing, 400038, China
| | - Gang Li
- Department of Pharmaceutics, College of Pharmacy, Third Military Medical University (Army Medical University), 30 Gaotanyan Main Street, Chongqing, 400038, China
| | - Yang Zhang
- Department of Pharmaceutics, College of Pharmacy, Third Military Medical University (Army Medical University), 30 Gaotanyan Main Street, Chongqing, 400038, China
| | - Jianxiang Zhang
- Department of Pharmaceutics, College of Pharmacy, Third Military Medical University (Army Medical University), 30 Gaotanyan Main Street, Chongqing, 400038, China.
- State Key Laboratory of Trauma, Burn and Combined Injury, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
| | - Jiawei Guo
- Department of Pharmaceutical Analysis, College of Pharmacy, Third Military Medical University (Army Medical University), 30 Gaotanyan Main Street, Chongqing, 400038, China.
| | - Dingde Huang
- Department of Nuclear Medicine, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Main Street, Chongqing, 400038, China.
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Kudo Y, Shimada Y, Matsubayashi J, Kitamura Y, Makino Y, Maehara S, Hagiwara M, Park J, Yamada T, Takeuchi S, Kakihana M, Nagao T, Ohira T, Masumoto J, Ikeda N. Artificial intelligence analysis of three-dimensional imaging data derives factors associated with postoperative recurrence in patients with radiologically solid-predominant small-sized lung cancers. Eur J Cardiothorac Surg 2021; 61:751-760. [DOI: 10.1093/ejcts/ezab541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/09/2021] [Accepted: 11/23/2021] [Indexed: 02/07/2023] Open
Abstract
Abstract
OBJECTIVES
Indications of limited resection, such as segmentectomy, have recently been reported for patients with solid-predominant lung cancers ≤2 cm. This study aims to identify unfavourable prognostic factors using three-dimensional imaging analysis with artificial intelligence (AI) technology.
METHODS
A total of 157 patients who had clinical N0 non-small cell lung cancer with a radiological size ≤2 cm, and a consolidation tumour ratio > 0.5, who underwent anatomical lung resection between 2011 and 2017 were enrolled. To evaluate the three-dimensional structure, the ground-glass nodule/Solid Automatic Identification AI software Beta Version (AI software; Fujifilm Corporation, Japan) was used.
RESULTS
Maximum standardized uptake value (SUVmax) and solid-part volume measured by AI software (AI-SV) showed significant differences between the 139 patients with adenocarcinoma and the 18 patients with non-adenocarcinoma. Among the adenocarcinoma patients, 42 patients (30.2%) were found to be pathological upstaging. Multivariable analysis demonstrated that high SUVmax, high carcinoembryonic antigen level and high AI-SV were significant prognostic factors for recurrence-free survival (RFS; P < 0.05). The 5-year RFS was compared between patients with tumours showing high SUVmax and those showing low SUVmax (67.7% vs 95.4%, respectively, P < 0.001). The 5-year RFS was 91.0% in patients with small AI-SV and 68.1% in those with high AI-SV (P = 0.001).
CONCLUSIONS
High AI-SV, high SUVmax and abnormal carcinoembryonic antigen level were unfavourable prognostic factors of patients with solid-predominant lung adenocarcinoma with a radiological size ≤2 cm. Our results suggest that lobectomy should be preferred to segmentectomy for patients with these prognostic factors.
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Affiliation(s)
- Yujin Kudo
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | | | - Jun Matsubayashi
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | | | - Yojiro Makino
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Sachio Maehara
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Masaru Hagiwara
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Jinho Park
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Takafumi Yamada
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Susumu Takeuchi
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | | | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Tatsuo Ohira
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Jun Masumoto
- Medical System Research & Development Center, FUJIFILM Corporation, Tokyo, Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
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8
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Kamigaichi A, Tsutani Y, Okada M. Reply to Zhang et al. Eur J Cardiothorac Surg 2021; 59:928. [PMID: 33346347 DOI: 10.1093/ejcts/ezaa419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/18/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Yasuhiro Tsutani
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
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9
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Tsutani Y, Shimada Y, Ito H, Miyata Y, Ikeda N, Nakayama H, Okada M. Identification of High-Risk of Recurrence in Clinical Stage I Non-Small Cell Lung Cancer. Front Oncol 2021; 11:622742. [PMID: 34164334 PMCID: PMC8215653 DOI: 10.3389/fonc.2021.622742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 05/06/2021] [Indexed: 12/25/2022] Open
Abstract
Objective This study aimed to identify patients at a high risk of recurrence using preoperative high-resolution computed tomography (HRCT) in clinical stage I non-small cell lung cancer (NSCLC). Methods A total of 567 patients who underwent screening and 1,216 who underwent external validation for clinical stage I NSCLC underwent lobectomy or segmentectomy. Staging was used on the basis of the 8th edition of the tumor–node–metastasis classification. Recurrence-free survival (RFS) was estimated using the Kaplan–Meier method, and the multivariable Cox proportional hazards model was used to identify independent prognostic factors for RFS. Results A multivariable Cox analysis identified solid component size (hazard ratio [HR], 1.66; 95% confidence interval [CI] 1.30–2.12; P < 0.001) and pure solid type (HR, 1.82; 95% CI 1.11–2.96; P = 0.017) on HRCT findings as independent prognostic factors for RFS. When patients were divided into high-risk (n = 331; solid component size of >2 cm or pure solid type) and low-risk (n = 236; solid component size of ≤2 cm and part solid type) groups, there was a significant difference in RFS (HR, 5.33; 95% CI 3.09–9.19; 5-year RFS, 69.8% vs. 92.9%, respectively; P < 0.001). This was confirmed in the validation set (HR, 5.32; 95% CI 3.61–7.85; 5-year RFS, 72.0% vs. 94.8%, respectively; P < 0.001). Conclusions In clinical stage I NSCLC, patients with a solid component size of >2 cm or pure solid type on HRCT were at a high risk of recurrence.
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Affiliation(s)
- Yasuhiro Tsutani
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Yoshihisa Shimada
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Yoshihiro Miyata
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Norihiko Ikeda
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Haruhiko Nakayama
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
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10
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Nakada T, Kuroda H. Narrative review of optimal prognostic radiological tools using computed tomography for T1N0-staged non-small cell lung cancer. J Thorac Dis 2021; 13:3171-3181. [PMID: 34164207 PMCID: PMC8182523 DOI: 10.21037/jtd-20-3380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Various radiological tools can predict the prognosis of non-small cell lung cancer (NSCLC). In this study, we evaluated the prognostic effect of different radiological tools such as whole tumor size (WTS), consolidation size (CS), consolidation tumor ratio (CTR), tumor disappearance ratio (TDR), mediastinal diameter (MD), and ground glass opacity (GGO) using high-resolution computed tomography (HRCT). We reviewed recent retrospective studies on the predictive effect of these radiological tools on disease-free survival (DFS) and overall survival (OS) in patients with T1N0-staged NSCLC. We searched PubMed and the British Library databases for the English literature published from January 2010 to December 2020 and generated a total of 32 publications (NSCLC, n=16; adenocarcinoma, n=16). The TNM classification version 7 was used in 18 studies, and version 8 in 14 studies. The evaluated radiological parameters were WTS, CS including T category, CTR, TDR, MD, presence of GGO, GGO ratio, and pure GGO. This review suggested that CS, MD, and the presence of GGO are optimal prognostic radiological tools for cT1N0-Staged NSCLC. CTR or TDR for part solid nodules (PSNs) is not a well-accepted prognostic factor. Further investigations are required to differentiate between benign scars and malignant components on HRCT and evaluate the prognosis of PSNs (1< CS ≤2 cm) with large WTS in the future.
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Affiliation(s)
- Takeo Nakada
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
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11
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Fu F, Wen Z, Gao Z, Zhao Y, Li Y, Zhang Y, Chen H. Primary Tumor Resection Improves Survival for EGFR-TKI-Treated Patients With Occult M1a Lung Adenocarcinoma. Front Oncol 2021; 11:622723. [PMID: 33954108 PMCID: PMC8092396 DOI: 10.3389/fonc.2021.622723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/30/2021] [Indexed: 12/25/2022] Open
Abstract
Background The role of primary tumor resection in occult M1a lung adenocarcinoma remains unclear, especially for patients receiving targeted therapy. The purpose of this study is to assess the effect of primary tumor resection on overall survival (OS) in lung adenocarcinoma patients with occult pleural disseminations receiving targeted therapy. Methods Lung adenocarcinoma patients with intraoperatively-confirmed occult pleural dissemination (M1a), who hospitalized in the Department of Thoracic Surgery in Fudan Shanghai Cancer Center from May 2008 to December 2017 and received EGFR-TKIs therapy, were enrolled. Log-rank tests were used to compare the survival differences between groups. Results 34 patients receiving EGFR-TKIs were enrolled. The majority of them were never smokers (29/34, 85.3%). Among the enrolled patients, 20 (58.8%) patients underwent primary tumor resection, while 14 (41.2%) patients not. There was no distributional difference of baselines between patients undergoing and not undergoing primary tumor resection. Further analyses demonstrated that the patients undergoing primary tumor resection had a prolonged OS compared with those not (log-rank P= 0.042). The 2-year and 5-year OS for patients receiving primary tumor resection and EGFR-TKIs was 90.0% and 60.1%. Conclusions Primary tumor resection was associated with improved survival in patients with occult intraoperatively-confirmed M1a adenocarcinoma receiving EGFR-TKIs.
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Affiliation(s)
- Fangqiu Fu
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhexu Wen
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhendong Gao
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yue Zhao
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuan Li
- Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yang Zhang
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Haiquan Chen
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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12
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Fan F, Zhang Y, Fu F, Gao Z, Zhao Y, Han H, Lai J, Wen Z, Ma X, Deng C, Ma Z, Wang S, Deng L, Li Y, Ye T, Chen H. Subsolid lesions exceeding 3 centimeters: the ground-glass opacity component still matters. Ann Thorac Surg 2021; 113:984-992. [PMID: 33839135 DOI: 10.1016/j.athoracsur.2021.03.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 01/28/2021] [Accepted: 03/01/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Recent studies on the favorable prognosis of ground-glass opacities (GGO) featured lung adenocarcinoma compared with solid nodules were limited to small tumors measuring ≤3.0 cm. This study aimed to investigate whether GGO component could predict better prognosis in patients with large subsolid lesions exceeding 3cm compared with small solid nodules within the same clinical T category. METHODS From 2010 to 2015, a total of 1010 patients with completely resected clinical N0 lung adenocarcinoma were enrolled, including 860 solid lesions and 150 subsolid lesions exceeding 3cm. To analyze the prognostic significance of GGO component, propensity score matching adjusting solid component size was performed. RESULTS After propensity score matching, 144 pairs of patients were finally analyzed. The mean size of the solid component was 23.7mm in the GGO group and 24.4mm in the solid group(p=0.450). The GGO group had significantly better overall survival and recurrence-free survival (p=0.011 and p=0.003, respectively), which were also validated in patients with solid-predominant lesions. Subgroup analysis showed the GGO group was associated with better prognosis in each clinical T category. CONCLUSIONS The prognosis of patients with GGO lesions exceeding 3cm was better than that of patients with small solid lesions even within the same clinical T category. Clinical T classification incorporating GGO component may provide better prognostic prediction for patients with lung cancer exceeding 3cm.
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Affiliation(s)
- Fanfan Fan
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yang Zhang
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fangqiu Fu
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhendong Gao
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yue Zhao
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Han Han
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jinglei Lai
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhexu Wen
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiangyi Ma
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chaoqiang Deng
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zelin Ma
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shengping Wang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Lin Deng
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yuan Li
- Institute of Thoracic Oncology, Fudan University, Shanghai, China; Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ting Ye
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Haiquan Chen
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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Hattori A, Matsunaga T, Takamochi K, Oh S, Suzuki K. Extent of mediastinal nodal dissection in stage I non-small cell lung cancer with a radiological pure-solid appearance. Eur J Surg Oncol 2021; 47:1797-1804. [PMID: 33745792 DOI: 10.1016/j.ejso.2021.03.232] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/19/2021] [Accepted: 03/07/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Radiological pure-solid lung cancer denotes a high invasive nature compared to one that is part-solid. Mediastinal lymph nodal dissection (mLND) is a standard surgical procedure for nodal management in lung cancer surgery, however, the prognostic impact of the extent of mLND in pure-solid lung cancer is still unknown. METHODS We reviewed 459 patients with c-stage I radiological pure-solid lung cancer that underwent pulmonary lobectomy with mLND. Pure-solid was defined as a tumor showing only a consolidation without any ground glass opacity. The extent of mLND was classified into lobe-specific (L-mLND) and systematic (S-mLND). Prognostic significance of mLND was assessed by a multivariable analysis using propensity-score matching. Survivals were calculated by Kaplan-Meier methods using log-rank test. RESULTS Pathological nodal metastasis was found in 127 (27.6%) patients (hilar: 52 (11.3%), mediastinal: 75 (16.3%)). L-mLND was performed in 278 (61%) patients. A multivariable analysis did not show the survival difference for the extent of mLND (p = 0.266). The 5-year overall survival (OS) was not significantly different between S-mLND and L-mLND (74.3% vs. 72.7%, p = 0.712), which was similar even in 114 propensity-score matched pairs (78.8% vs. 79.9%, p = 0.665). While S-mLND showed a trend for survival benefit compared to L-mLND provided that the tumor showed higher standardized uptake value (SUVmax) (5y-OS: 70.0% vs. 59.2%, p = 0.093). CONCLUSIONS Prognostic impact of L-mLND was similar to S-mLND in c-stage I radiological pure-solid lung cancers in the propensity-score matched comparison. Among them, higher SUVmax value might be a promising indicator to decide the extent of mediastinal lymphadenectomy.
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Affiliation(s)
- Aritoshi Hattori
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
| | - Takeshi Matsunaga
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shiaki Oh
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Hino H, Utsumi T, Maru N, Matsui H, Taniguchi Y, Saito T, Murakawa T. Clinical impact and utility of positron emission tomography on occult lymph node metastasis and survival: radical surgery for stage I lung cancer. Gen Thorac Cardiovasc Surg 2021; 69:1196-1203. [PMID: 33609239 DOI: 10.1007/s11748-021-01606-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/10/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The surgical result of early-staged lung cancer is not satisfactory due to unexpected postoperative lymph node metastasis and recurrence. This study aimed to investigate which preoperative factors-including the standard uptake value max (SUVmax) of positron emission tomography-could predict occult lymph node metastasis and survival. METHODS We retrospectively analyzed data from 598 patients with clinical stage I lung cancer who underwent surgery, and examined their preoperative clinical characteristics. RESULTS A total of 1586 patients had surgery for primary lung cancer between 2006 and 2019; 598 patients with clinical stage I lung cancer were the study inclusion; occult lymph node metastasis was detected in 102 (17.1%). Univariable and multivariable analyses showed that SUVmax ≥ 3 (P < 0.001), clinical invasive tumor size ≥ 2 cm (P = 0.009), and carcinoembryonic antigen > 5 (P = 0.03) were associated with significant risk factors rated (%) for occult lymph node metastasis, as follows: high-risk group (three factors), moderate-risk group (two factors) and low-risk group (one factor or none) corresponding to 32.2 (28/87), 22.8 (41/180) and 7.3 (19/262), respectively (P < 0.001). The 5-year overall survival rates (%) of patients without lymph node metastasis holding SUVmax 6 or over were as poor as those of patients with lymph node metastasis (72.0% vs 64.1%; P = 0.56). CONCLUSIONS We might consider wedge resection or segmentectomy, omitting lymphadenectomy, for the low-risk group; adjuvant therapy is indicated for patients without lymph node metastasis having SUVmax 6 or over.
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Affiliation(s)
- Haruaki Hino
- Department of Thoracic Surgery, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan.
| | - Takahiro Utsumi
- Department of Thoracic Surgery, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Natsumi Maru
- Department of Thoracic Surgery, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Hiroshi Matsui
- Department of Thoracic Surgery, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Yohei Taniguchi
- Department of Thoracic Surgery, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Tomohito Saito
- Department of Thoracic Surgery, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Tomohiro Murakawa
- Department of Thoracic Surgery, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
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15
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Kagimoto A, Tsutani Y, Handa Y, Mimae T, Miyata Y, Okada M. Clinical features and prognosis of clinical N0 non-small cell lung cancer exceeding 30 mm. Jpn J Clin Oncol 2020; 50:1306-1312. [PMID: 32901276 DOI: 10.1093/jjco/hyaa167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/14/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES This study aimed to determine the characteristics, ground glass opacity ratio and prognosis of patients with clinical N0 non-small cell lung cancer tumours exceeding 30 mm in size. METHODS Patients with clinical N0 non-small cell lung cancer and total tumour size >30 mm on preoperative computed tomography who underwent complete resection with lobectomy between January 2007 and December 2017 were included. The patients were divided into three groups: pure solid tumour, low ground glass opacity ratio (1-39%) tumour and high ground glass opacity ratio (≥40%) tumour. The cut-off line was determined based on the recurrence rate for every 10% ground glass opacity ratio. RESULTS Among the 227 study patients, 129 (56.8%) had a pure solid tumour, 54 (23.8%) had a low ground glass opacity ratio tumour and 44 (19.4%) had a high ground glass opacity ratio tumour. Three-year recurrence-free survival was significantly shorter in patients with a pure solid tumour (57.4%) than in patients with a low ground glass opacity ratio (74.5%; P = 0.009) or a high ground glass opacity ratio tumour (92.1%; P < 0.001). Multivariable analysis showed that ground glass opacity ratio was a significant independent prognostic factor for recurrence-free survival (hazard ratio, 0.175; P = 0.037). CONCLUSION Pure solid tumours comprised a large proportion of non-small cell lung cancer tumours >30 mm in size and their prognosis was poor. The presence of ground glass opacity and their relative proportion affect prognosis in patients with clinical N0 non-small cell lung cancer tumours >30 mm in size, similar to those with small-sized tumours.
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Affiliation(s)
- Atsushi Kagimoto
- Department of Surgical oncology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yasuhiro Tsutani
- Department of Surgical oncology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yoshinori Handa
- Department of Surgical oncology, Hiroshima University Hospital, Hiroshima, Japan
| | - Takahiro Mimae
- Department of Surgical oncology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yoshihiro Miyata
- Department of Surgical oncology, Hiroshima University Hospital, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical oncology, Hiroshima University Hospital, Hiroshima, Japan
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16
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Kagimoto A, Tsutani Y, Kushitani K, Kai Y, Kambara T, Miyata Y, Takeshima Y, Okada M. Segmentectomy vs Lobectomy for Clinical Stage IA Lung Adenocarcinoma With Spread Through Air Spaces. Ann Thorac Surg 2020; 112:935-943. [PMID: 33144104 DOI: 10.1016/j.athoracsur.2020.09.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 09/05/2020] [Accepted: 09/21/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND This study aimed to investigate the prognosis after segmentectomy as compared with lobectomy for small-sized lung adenocarcinoma with spread through air spaces (STAS). METHODS This retrospective study included 609 patients who underwent lobectomy or segmentectomy with lymph node dissection for clinical stage IA lung adenocarcinoma between April 2011 and March 2020 at Hiroshima University Hospital. Patient characteristics and prognosis after segmentectomy and lobectomy were investigated. RESULTS STAS was detected in 293 patients (48.1%). The recurrence-free survival (RFS) rate was significantly worse with STAS-positive adenocarcinoma than with STAS-negative adenocarcinoma both in patients who underwent lobectomy (5-year RFS, 68.2% vs 90.2%; P < .001) and in patients who underwent segmentectomy (5-year RFS, 81.3% vs 93.0%; P = .003). Among the patients with STAS, there was no significant difference in RFS between patients who underwent lobectomy (5-year RFS, 68.2%) and those who underwent segmentectomy (5-year RFS, 81.3%; P = .225). In a multivariable analysis using propensity score to adjust clinical patient characteristics, segmentectomy was not found to be an independent prognostic factor of RFS (hazard ratio 0.732, P = .326) among patients with STAS. Among the patients with STAS, only 1 patient (1%) with insufficient resection margin (0.5 mm) had local recurrence and 1 patient (1%) with invasive mucinous adenocarcinoma had recurrence in preserved lobe after segmentectomy. CONCLUSIONS Spread through air spaces was a poor prognostic factor in patients with clinical stage IA lung adenocarcinoma. Prognosis after segmentectomy was comparable with that of lobectomy in lung adenocarcinoma with STAS without increasing locoregional recurrence.
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Affiliation(s)
- Atsushi Kagimoto
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Yasuhiro Tsutani
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Kei Kushitani
- Department of Pathology, Hiroshima University, Hiroshima, Japan
| | - Yuichiro Kai
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | | | - Yoshihiro Miyata
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Yukio Takeshima
- Department of Pathology, Hiroshima University, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
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Kagimoto A, Tsutani Y, Izaki Y, Handa Y, Mimae T, Miyata Y, Okada M. Prediction of Lymph Node Metastasis Using Semiquantitative Evaluation of PET for Lung Adenocarcinoma. Ann Thorac Surg 2020; 110:1036-1042. [DOI: 10.1016/j.athoracsur.2020.03.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/08/2020] [Accepted: 03/16/2020] [Indexed: 02/06/2023]
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18
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Tsutani Y, Nakayama H, Ito H, Handa Y, Mimae T, Miyata Y, Okada M. Long-Term Outcomes After Sublobar Resection Versus Lobectomy in Patients With Clinical Stage IA Lung Adenocarcinoma Meeting the Node-Negative Criteria Defined by High-Resolution Computed Tomography and [ 18F]-Fluoro-2-Deoxy-d-Glucose Positron Emission Tomography. Clin Lung Cancer 2020; 22:e431-e437. [PMID: 32665166 DOI: 10.1016/j.cllc.2020.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/29/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate long-term outcomes after sublobar resection for patients with clinical stage IA lung adenocarcinoma who met our proposed node-negative (N0) criteria, namely solid component size < 0.8 cm on high-resolution computed tomography (HRCT) or a maximum standardized uptake value (SUVmax) of < 1.5 on [18F]-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG-PET/CT). PATIENTS AND METHODS Between April 2006 and December 2010, a total of 347 patients with clinical stage IA lung adenocarcinoma underwent complete resection in two medical centers. Long-term outcomes of patients with disease that met the N0 criteria after sublobar resection were evaluated. RESULTS The disease of 201 patients (57.9%) met the N0 criteria. Meeting N0 criteria was significantly associated with low-grade adenocarcinoma subtype (P < .001) and absence of lymphatic invasion (P < .001), vascular invasion (P < .001), and pleural invasion (P < .001). One patient (0.5%) had lymph node metastasis. The median follow-up period was 86.1 months. There was a significant difference in the overall survival (OS) rates between patients with disease that met the N0 criteria (5-year OS, 93.9%; 10-year OS, 90.3%) and disease that did not (5-year OS, 81.5%; 10-year OS, 64.3%; P < .001). Among patients with disease that met the N0 criteria, there was no significant difference in the OS between those who underwent lobectomy (5-year OS, 94.3%; 10-year OS, 92.6%) and those who underwent sublobar resection (5-year OS, 93.8%; 10-year OS, 89.3%; P = .64). CONCLUSIONS Sublobar resection of clinical stage IA lung adenocarcinoma is feasible in selected patients with disease that meets the N0 criteria, with excellent long-term survival.
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Affiliation(s)
- Yasuhiro Tsutani
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Haruhiko Nakayama
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Yoshinori Handa
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Takahiro Mimae
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Yoshihiro Miyata
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
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19
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New T1 classification. Gen Thorac Cardiovasc Surg 2019; 68:665-671. [PMID: 31679135 DOI: 10.1007/s11748-019-01233-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 10/11/2019] [Indexed: 10/25/2022]
Abstract
The IASLC staging and Prognostic Factor Committee proposed new changes to the descriptors for the 8th edition of the Tumour Node Metastasis Staging for Lung Cancer. The T1 descriptor changes include (1) T1 tumours are subclassified into T1a (< 1 cm), T1b (> 1 to < 2 cm), T1c (> 2 to < 3 cm). The corresponding changes are introduced to the overall staging: T1aN0M0 = Stage IA1; T1bN0M0 = Stage IA2; T1cN0M0 = Stage IA3. (2) The introduction of the pathological entities Adenocarcinoma-In-Situ (AIS), Minimally Invasive Adenocarcinoma, and Lepidic Predominant Adenocarcinoma. The corresponding changes on the T descriptor are as follows: Adenocarcinoma-in situ is coded as Tis (AIS); Minimally Invasive Adenocarcinoma is coded as T1a(mi). In this review, the basis for these changes will be described, and the implications on clinical practice will be discussed.
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20
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Kim H, Goo JM, Paeng JC, Kim YT, Park CM. Evaluation of maximum standardized uptake value at fluorine-18 fluorodeoxyglucose positron emission tomography as a complementary T factor in the eighth edition of lung cancer stage classification. Lung Cancer 2019; 134:151-157. [DOI: 10.1016/j.lungcan.2019.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/28/2019] [Accepted: 06/12/2019] [Indexed: 12/25/2022]
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21
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Clinical T categorization in stage IA lung adenocarcinomas: prognostic implications of CT display window settings for solid portion measurement. Eur Radiol 2019; 29:6069-6079. [DOI: 10.1007/s00330-019-06216-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/04/2019] [Accepted: 04/02/2019] [Indexed: 12/17/2022]
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22
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Jiang T, Li M, Lin M, Zhao M, Zhan C, Feng M. Meta-analysis of comparing part-solid and pure-solid tumors in patients with clinical stage IA non-small-cell lung cancer in the eighth edition TNM classification. Cancer Manag Res 2019; 11:2951-2961. [PMID: 31114343 PMCID: PMC6497478 DOI: 10.2147/cmar.s196613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/25/2019] [Indexed: 12/23/2022] Open
Abstract
Objective: The aim of the study was to compare the prognoses between part-solid and pure-solid tumors for clinical stage IA non-small-cell lung cancer (NSCLC) patients in the eighth edition TNM classification. Methods: We searched the literature in PubMed and Web of Science for all eligible articles published before November 31, 2018. The pooled data included overall survival (OS), disease-free survival (DFS) and recurrence-free survival (RFS). The hazard ratio (HR) of OS (pure-solid/part-solid) was used as the measure of differential effects. Pure-solid or part-solid tumors in all studies included were matched according to the solid component size or according to the eighth edition TNM classification.
Results: Seven studies including 2,037 patients with c-stage IA NSCLC were pooled in the meta-analysis. Patients with pure-solid tumors had significantly poorer OS (HR 1.69, 95% CI 1.21‒2.35, P=0.002), DFS (HR 1.27, 95% CI 1.07‒1.51, P=0.006) and RFS (HR 1.74, 95% CI 1.08‒2.80, P=0.020). In subgroup analyses, when the meta-analysis was limited to T1a-1b (≤2 cm) lung cancer, the prognosis for pure-solid tumors was inferior to that for part-solid tumors regarding both OS and RFS. In adenocarcinoma subgroup, there was no difference between the two groups in terms of OS and RFS, but we detected a meaningful difference in DFS.
Conclusion: Part-solid tumors may have a better prognosis than pure-solid tumors in clinical stage IA patients according to the eighth edition TNM classification, and similar results were found for the T1a-1b (≤2 cm) subgroup. There were no substantial differences in OS and RFS between two groups in lung adenocarcinoma. However, we detected a meaningful difference in DFS, which might also suggest a superior prognosis for part-solid tumors. We propose that the part-solid and pure-solid tumors in the same T component category be considered separately.
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Affiliation(s)
- Tian Jiang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, People's Republic of China
| | - Ming Li
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, People's Republic of China
| | - Miao Lin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, People's Republic of China
| | - Mengnan Zhao
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, People's Republic of China
| | - Cheng Zhan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, People's Republic of China
| | - Mingxiang Feng
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, People's Republic of China
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Anderson KR, Onken A, Heidinger BH, Chen Y, Bankier AA, VanderLaan PA. Pathologic T Descriptor of Nonmucinous Lung Adenocarcinomas Now Based on Invasive Tumor Size: How Should Pathologists Measure Invasion? Am J Clin Pathol 2018; 150:499-506. [PMID: 30084917 DOI: 10.1093/ajcp/aqy080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The eighth edition of the American Joint Committee on Cancer staging manual now stratifies nonmucinous lung adenocarcinomas (nmLACAs) by the size of the invasive component only. This is determined by direct gross or microscopic measurement; however, a calculated invasive size based on the percentage of invasive growth patterns has been proposed as an alternative option. METHODS To compare radiologic with different pathologic assessments of invasive tumor size, we retrospectively reviewed a cohort of resected nmLACAs with a part-solid appearance on computed tomography (CT) scan (n = 112). RESULTS The median direct microscopic pathologic invasive measurements were not significantly different from the median calculated pathologic invasive measurements; however, the median CT invasive measurements were 0.26 cm larger than the median direct pathologic measurements (P < .001). CONCLUSIONS Our results show that pathologic calculated invasive tumor measurements are comparable to direct microscopic measurements of invasive tumor, thereby supporting the recommendation for use of calculated invasive tumor size by the pathologist if necessary.
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Affiliation(s)
- Kevin R Anderson
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Allison Onken
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Benedikt H Heidinger
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Yigu Chen
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Alexander A Bankier
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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24
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Li S, Yang R, Sun X, Miao S, Lu T, Wang Y, Wo Y, Jiao W. Identification of SPP1 as a promising biomarker to predict clinical outcome of lung adenocarcinoma individuals. Gene 2018; 679:398-404. [PMID: 30240883 DOI: 10.1016/j.gene.2018.09.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 09/13/2018] [Accepted: 09/17/2018] [Indexed: 01/10/2023]
Abstract
We identified and investigated the prognostic value of secreted phosphoprotein 1 (SPP1) in lung adenocarcinoma (LUAD) patients and evaluate the relationship between the SPP1 expression level and clinical characteristics. First, SPP1 was identified through four LUAD datasets in GEO database and validated by the TCGA database. Then a total of 149 lung adenocarcinoma patients were included, as well as their clinicopathological characteristics collected in the study. The expression levels of SPP1 and adjacent normal tissues were assessed by immunohistochemistry. The association between SPP1 and its prognostic value was systematically evaluated. Results showed high SPP1 level predicted poorer LUAD survival by univariate Cox analysis (P = 0.017), and the multivariate result was also significant (P = 0.021). Subgroup analysis suggested the prognostic value of SPP1 was significant in stage T1 (log rank P = 0.011), stage N0 (log rank P = 0.046) and stage N1 (log rank P = 0.009) patients. After including these markers into a nomogram, the Harrell's C-index of the nomogram was 0.694. In summary, our findings suggest that SPP1 is an independent biomarker with prognostic significance in LUAD.
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Affiliation(s)
- Shicheng Li
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, China
| | - Ronghua Yang
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, China
| | - Xiao Sun
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, China
| | - Shuncheng Miao
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, China
| | - Tong Lu
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, China
| | - Yuanyong Wang
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, China
| | - Yang Wo
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, China
| | - Wenjie Jiao
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, China.
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Kamiya S, Iwano S, Umakoshi H, Ito R, Shimamoto H, Nakamura S, Naganawa S. Computer-aided Volumetry of Part-Solid Lung Cancers by Using CT: Solid Component Size Predicts Prognosis. Radiology 2018. [DOI: 10.1148/radiol.2018172319] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Shinichiro Kamiya
- From the Department of Radiology (S.K., S.I., H.U., R.I., H.S., Shinji Naganawa) and Department of Thoracic Surgery (Shota Nakamura), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Shingo Iwano
- From the Department of Radiology (S.K., S.I., H.U., R.I., H.S., Shinji Naganawa) and Department of Thoracic Surgery (Shota Nakamura), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Hiroyasu Umakoshi
- From the Department of Radiology (S.K., S.I., H.U., R.I., H.S., Shinji Naganawa) and Department of Thoracic Surgery (Shota Nakamura), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Rintaro Ito
- From the Department of Radiology (S.K., S.I., H.U., R.I., H.S., Shinji Naganawa) and Department of Thoracic Surgery (Shota Nakamura), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Hironori Shimamoto
- From the Department of Radiology (S.K., S.I., H.U., R.I., H.S., Shinji Naganawa) and Department of Thoracic Surgery (Shota Nakamura), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Shota Nakamura
- From the Department of Radiology (S.K., S.I., H.U., R.I., H.S., Shinji Naganawa) and Department of Thoracic Surgery (Shota Nakamura), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Shinji Naganawa
- From the Department of Radiology (S.K., S.I., H.U., R.I., H.S., Shinji Naganawa) and Department of Thoracic Surgery (Shota Nakamura), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
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26
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Fu L, Alam MS, Ren Y, Guan W, Wu H, Wang Q, Han Y, Zhou W, Li H, Wang Z. Utility of Maximum Standard Uptake Value as a Predictor for Differentiating the Invasiveness of T1 Stage Pulmonary Adenocarcinoma. Clin Lung Cancer 2018; 19:221-229. [DOI: 10.1016/j.cllc.2017.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022]
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27
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Akimoto E, Kadoya T, Kajitani K, Emi A, Shigematsu H, Ohara M, Masumoto N, Okada M. Role of 18 F-PET/CT in Predicting Prognosis of Patients With Breast Cancer After Neoadjuvant Chemotherapy. Clin Breast Cancer 2018; 18:45-52. [DOI: 10.1016/j.clbc.2017.09.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 08/06/2017] [Accepted: 09/01/2017] [Indexed: 01/14/2023]
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28
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Bucciarelli PR, Tan KS, Chudgar NP, Brandt W, Montecalvo J, Eguchi T, Liu Y, Aly R, Travis WD, Adusumilli PS, Jones DR. BRMS1 Expression in Surgically Resected Lung Adenocarcinoma Predicts Future Metastases and Is Associated with a Poor Prognosis. J Thorac Oncol 2018; 13:73-84. [PMID: 29097253 PMCID: PMC5738269 DOI: 10.1016/j.jtho.2017.10.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/04/2017] [Accepted: 10/05/2017] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Expression of breast cancer metastasis suppressor 1 gene (BRMS1) is decreased in NSCLC cells and tumors. We hypothesized that intratumoral breast cancer metastasis suppressor 1 (BRMS1) expression is associated with lung adenocarcinoma (LUAD) histologic subtypes and overall survival (OS) and disease-free survival (DFS) in patients undergoing resection for early-stage LUAD. METHODS Patients (N = 1030) who underwent complete resection for LUAD with tissue available for histologic evaluation were identified. Tissue microarrays were constructed, and immunostaining was performed and scored for intensity of BRMS1 expression. OS and DFS were estimated (by the Kaplan-Meier method) and compared between groups (by the log-rank test), stratified by stage. Hazard ratios (HRs) for hazard of death and recurrence were estimated using univariable and multivariable Cox proportional hazards models. OS and DFS nomograms were created, and model performance was examined. RESULTS Intratumoral BRMS1 expression was high in 632 patients (61%) and low in 398 (39%). Low BRMS1 expression was associated with higher pathologic T stage (p = 0.001), larger tumor size (p ≤ 0.0001), greater lymphatic (p = 0.032) and vascular (p = 0.001) invasion, LUAD histologic subtype (p = 0.001), and intermediate and high architectural tumor grade (p = 0.003). Low BRMS1 expression was an independent predictor of worse OS (HR = 1.35, 95% confidence interval: 1.10-1.65, p = 0.004) and DFS (HR = 1.27, 95% confidence interval: 1.05-1.54, p = 0.012). OS and DFS nomograms showed excellent predictive performance based on discrimination and calibration. CONCLUSIONS Among patients with surgically resected LUAD, OS and DFS were significantly worse in cases with low intratumoral BRMS1 expression. Our findings suggest that BRMS1 is an independent biomarker with prognostic significance in surgically resected LUAD.
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Affiliation(s)
- Peter R Bucciarelli
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kay See Tan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Neel P Chudgar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Whitney Brandt
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joseph Montecalvo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Takashi Eguchi
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yuan Liu
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rania Aly
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Prasad S Adusumilli
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David R Jones
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
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29
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Huang L, Li W, Zhao L, Li B, Chai Y. Risk factors of lymph node metastasis in lung squamous cell carcinoma of 3 cm or less in diameter. Medicine (Baltimore) 2017; 96:e7563. [PMID: 28723786 PMCID: PMC5521926 DOI: 10.1097/md.0000000000007563] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Through literature review we cannot find an efficient risk factor of lymph node metastasis in lung squamous cell carcinoma (SCC). This study aimed to investigate the risk factors of pathological lymph node status in patients with lung SCC of 3 cm or less in diameter, to provide some reference for the fellow surgeons in the decision of operative option.In total, we analyzed 154 patients with lung SCC of 3 cm or less in diameter who underwent lobectomy or bilobectomy or pneumonectomy with systematic lymph node dissection. The relationship between lymph node status and clinical characteristics were examined.Lymph node metastases were present in 48 patients (31.2%) of the study subjects. Multivariate analysis indicated that, age <60 years old (P = .007), tumor location of central-type (P = .003), tumor long axis >2 cm but ≤3 cm (P = .047) were associated with lymph node metastasis, and their odd ratios (OR) were 3.120, 3.359, and 5.196, respectively. Group analysis of the 74 peripheral lung SCC showed that those with the tumor long axis ≤2 cm had a lower rate of lymph node metastasis (7.9% vs 27.8%, P = .025).Age <60 years old, tumor location of central-type, and tumor long axis >2 cm but ≤3 cm are risk factors of lymph node metastasis in lung SCC. Systematic lymph node dissection or sampling is recommended when tumor central-type location and/or long axis >2 cm in lung SCC are present.
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Affiliation(s)
| | | | | | - Baizhou Li
- Pathology Department, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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30
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Kim W, Lee HY, Jung SH, Woo MA, Kim HK, Choi YS, Kim J, Zo JI, Shim YM, Han J, Jeong JY, Choi JY, Lee KS. Dynamic prognostication using conditional survival analysis for patients with operable lung adenocarcinoma. Oncotarget 2017; 8:32201-32211. [PMID: 27793026 PMCID: PMC5458278 DOI: 10.18632/oncotarget.12920] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/21/2016] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To evaluate conditional survival among patients with surgically resected stage I-IIIa lung adenocarcinoma and identify changes in prognostic contributions for various prognostic factors over time. PATIENTS AND METHODS We performed conditional survival analysis at each t0 (=0, 1, 2, 3, 4, 5 years) for 723 consecutive patients who underwent surgical resection for lung adenocarcinoma, stratified by various clinico-demographic features, as well as pathologic and imaging (tumor-shadow disappearance ratio [TDR] on CT and maximum standardized uptake value [SUVmax] on PET) characteristics. Uni- and multivariableCox regression analyses were performed to evaluate relationships between those variables and conditional survival. RESULTS Three-year conditional overall survival (OS) and disease-free survival (DFS) were 92.12% and 75.51% at baseline, but improved steadily up to 98.33% and 95.95% at 5 years after surgery. In contrast to demographic factors, pathologic (stage, subtype, pathologic grade and differentiation) and radiologic factors (TDR and SUVmax) maintained a statistically significant association with subseqeunt 3-year OS until 3 years after surgery. According to the multivariableanalysis, high SUVmax and low TDR value were independent predictors of subsequent 3-year OS and DFS at baseline, 1 and 2 years after surgery, respectively. CONCLUSION Our findings based on CS provide theoretical background for clinicians to plan longer period of surveillance following lung adenocarcinoma resection in survivors with preoperatively high SUVmax and low TDR on PET-CT and chest CT, respectively.
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Affiliation(s)
- Wooil Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Yun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sin-Ho Jung
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min-Ah Woo
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Kwan Kim
- Department of Thoracic Surgery and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Soo Choi
- Department of Thoracic Surgery and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jhingook Kim
- Department of Thoracic Surgery and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Ill Zo
- Department of Thoracic Surgery and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Mog Shim
- Department of Thoracic Surgery and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joungho Han
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Yun Jeong
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Pathology, Kyungpook National University Medical, Center, Kyungpook National University School of Medicine, Daegu, Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Soo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lococo F, Galeone C, Formisano D, Bellafiore S, Filice A, Annunziata T, Cesario A, Rapicetta C, Fioroni F, Ricchetti T, Paci M. 18F-fluorodeoxyglucose positron emission tomographic scan in solid-type p-stage-I pulmonary adenocarcinomas: what can produce false-negative results?†. Eur J Cardiothorac Surg 2017:ezw394. [DOI: 10.1093/ejcts/ezw394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
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Role of CT and PET Imaging in Predicting Tumor Recurrence and Survival in Patients with Lung Adenocarcinoma: A Comparison with the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society Classification of Lung Adenocarcinoma. J Thorac Oncol 2016; 10:1785-94. [PMID: 26473646 DOI: 10.1097/jto.0000000000000689] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Recently, a new lung adenocarcinoma classification scheme was published. The prognostic value of this new classification has not been elaborated together with the value of imaging biomarkers including computed tomography (CT) and positron emission tomography (PET). METHODS We reviewed pathologic specimens and imaging characteristics of primary tumors from 723 consecutive patients who underwent surgical resection for lung adenocarcinoma. On pathology, the predominant histologic subtype and pattern group were quantified. Tumor-shadow disappearance ratio (TDR) on CT and maximum standardized uptake value (SUVmax) on PET were assessed. The relationships between those variables and survival (overall survival [OS] and disease-free survival) were analyzed by using Kaplan-Meier curves and Cox regression analyses. RESULTS The median follow-up period was 3.8 years. There were 137 patients (19%) with recurrence and 167 patients (23%) with metastasis after surgical resection. Among 723 patients, 35 patients (4.8%) had adenocarcinoma in situ, 34 patients (4.7%) had minimally invasive adenocarcinoma, 125 patients (17.3%) had lepidic predominant, 314 patients (43.4%) had acinar predominant, 65 patients (9.0%) had papillary predominant, 23 patients (3.2%) had micropapillary predominant, 113 patients (15.6%) had solid predominant, and 14 patients (1.9%) had variant adenocarcinomas. OS and disease-free survival rates were significantly different according to TDR on CT and SUVmax on PET, predominant subtypes, and pattern groups. On multivariate analysis, the SUVmax (p < 0.001), TDR (p = 0.038), and pattern group (p = 0.015) were independent predictors of OS. CONCLUSIONS TDR on CT, SUVmax on PET, and the new histologic classification schemes appear to be promising parameters for the prognostic stratification of patients with lung adenocarcinomas, allowing for the triage of patients who necessitate further staging workup and adjuvant therapy.
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Travis WD, Asamura H, Bankier AA, Beasley MB, Detterbeck F, Flieder DB, Goo JM, MacMahon H, Naidich D, Nicholson AG, Powell CA, Prokop M, Rami-Porta R, Rusch V, van Schil P, Yatabe Y. The IASLC Lung Cancer Staging Project: Proposals for Coding T Categories for Subsolid Nodules and Assessment of Tumor Size in Part-Solid Tumors in the Forthcoming Eighth Edition of the TNM Classification of Lung Cancer. J Thorac Oncol 2016; 11:1204-1223. [PMID: 27107787 DOI: 10.1016/j.jtho.2016.03.025] [Citation(s) in RCA: 478] [Impact Index Per Article: 59.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/21/2016] [Accepted: 03/24/2016] [Indexed: 12/15/2022]
Abstract
This article proposes codes for the primary tumor categories of adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) and a uniform way to measure tumor size in part-solid tumors for the eighth edition of the tumor, node, and metastasis classification of lung cancer. In 2011, new entities of AIS, MIA, and lepidic predominant adenocarcinoma were defined, and they were later incorporated into the 2015 World Health Organization classification of lung cancer. To fit these entities into the T component of the staging system, the Tis category is proposed for AIS, with Tis (AIS) specified if it is to be distinguished from squamous cell carcinoma in situ (SCIS), which is to be designated Tis (SCIS). We also propose that MIA be classified as T1mi. Furthermore, the use of the invasive size for T descriptor size follows a recommendation made in three editions of the Union for International Cancer Control tumor, node, and metastasis supplement since 2003. For tumor size, the greatest dimension should be reported both clinically and pathologically. In nonmucinous lung adenocarcinomas, the computed tomography (CT) findings of ground glass versus solid opacities tend to correspond respectively to lepidic versus invasive patterns seen pathologically. However, this correlation is not absolute; so when CT features suggest nonmucinous AIS, MIA, and lepidic predominant adenocarcinoma, the suspected diagnosis and clinical staging should be regarded as a preliminary assessment that is subject to revision after pathologic evaluation of resected specimens. The ability to predict invasive versus noninvasive size on the basis of solid versus ground glass components is not applicable to mucinous AIS, MIA, or invasive mucinous adenocarcinomas because they generally show solid nodules or consolidation on CT.
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Affiliation(s)
- William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University, School of Medicine, Tokyo, Japan
| | - Alexander A Bankier
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mary Beth Beasley
- Department of Pathology, Ichan School of Medicine at Mount Sinai, New York, New York
| | - Frank Detterbeck
- Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Douglas B Flieder
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Heber MacMahon
- Department of Radiology, University of Chicago, Chicago, Illinois
| | - David Naidich
- Department of Radiology, New York University Langone Medical Center, New York University, New York, New York
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield National Health Service Foundation Trust and Imperial College, London, United Kingdom
| | - Charles A Powell
- Pulmonary Critical Care and Sleep Medicine, Ichan School of Medicine, New York, New York
| | - Mathias Prokop
- Department of Radiology, Radboud University Nymegen Medical Center, Nymegen, The Netherlands
| | - Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain; CIBERES Lung Cancer Group, Terrassa, Barcelona, Spain
| | - Valerie Rusch
- Thoracic Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Yasushi Yatabe
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
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Takenaka T, Yamazaki K, Miura N, Mori R, Takeo S. The Prognostic Impact of Tumor Volume in Patients with Clinical Stage IA Non-Small Cell Lung Cancer. J Thorac Oncol 2016; 11:1074-80. [PMID: 26899756 DOI: 10.1016/j.jtho.2016.02.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 02/05/2016] [Accepted: 02/06/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Tumor volume promises to be an important factor for predicting the prognosis of patients with non-small cell lung cancer (NSCLC). METHODS A total of 255 patients who underwent curative surgical resection for clinical stage IA NSCLC were included. We performed semiautomated measurement of the whole tumor volume and the volume of the solid part (referred to as the solid part volume) from a volumetric analysis of chest three-dimensional computed tomography scans using the SYNAPSE VINCENT imaging software program (Fujifilm Medical, Tokyo, Japan). We evaluated the relationships among tumor size, tumor volume, and survival. RESULTS The mean whole tumor size, the ratio of the maximum diameter of consolidation to the maximum tumor diameter (CTR), the whole tumor volume, and the solid part volume were 20 mm (range 0-30 mm), 0.84 (range 0-1.0), 3080 mm(3) (range 123-17509 mm(3)), and 2032 mm(3) (0-12466 mm(3)), respectively. The receiver operating characteristic area under the curve for the whole tumor size, CTR, whole tumor volume, and solid part volume used to identify recurrence were 0.60, 0.68, 0.58, and 0.69, respectively. A univariate analysis revealed that the whole tumor size, CTR, whole tumor volume, and solid part volume were associated with disease-free survival (DFS). A multivariate analysis of these factors identified the solid part volume to be the only independent factor for the prediction of DFS. CONCLUSIONS The whole tumor volume and the solid part volume were associated with DFS. In particular, the solid part volume was a very useful factor for predicting prognosis in clinical stage IA NSCLC.
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Affiliation(s)
- Tomoyoshi Takenaka
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan.
| | - Koji Yamazaki
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Naoko Miura
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Ryo Mori
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Sadanori Takeo
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
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The prognostic value of tumor shadow disappearance rate on integrated PET/CT evaluation of solitary pulmonary nodules with low glucose metabolism. Nucl Med Commun 2016; 37:356-62. [PMID: 26796032 DOI: 10.1097/mnm.0000000000000446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to determine the prognostic value of the tumor shadow disappearance rate (TDR) on integrated PET/computed tomography (PET/CT) evaluation of solitary pulmonary nodules (SPNs) with low glucose uptake. MATERIALS AND METHODS From January 2008 to September 2010, 99 patients who underwent fluorine-18 fluorodeoxyglucose PET (F-FDG-PET)/CT scanning for the evaluation of SPNs with a maximum standardized uptake value (SUVmax) below 2.75 (2.5+10%) were retrospectively reviewed. Among the 99 SPNs from these patients, 67 were malignant and 32 were benign, based on surgical pathology. Differences in baseline characteristics between the two groups were examined by means of the independent t-test, the Mann-Whitney U-test, and the χ-test. To test the efficacy of TDR for determining malignancy, the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and positive and negative likelihood ratios (LR+ and LR-, respectively) with 95% confidence intervals were calculated using the pathological test as the gold standard. RESULTS Patients with malignant nodules were older than those with benign nodules (64.5 vs. 55.1 years, respectively, P<0.001) and had higher TDRs (0.8 vs. 0.3, respectively, P<0.001). The optimal cutoff point for the TDR was 0.4886 where the sensitivity, specificity, positive predictive value, and negative predictive value were 0.851, 0.844, 0.919, and 0.730, respectively, and the LR+ and LR- were 5.443 and 0177, respectively. A significant negative correlation between TDR and SUVmax was found only in the malignant group. CONCLUSION The diagnostic value of TDR complements the PET/CT evaluation of SPNs with a low F-FDG uptake.
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Prognostic impact of nomogram based on whole tumour size, tumour disappearance ratio on CT and SUVmax on PET in lung adenocarcinoma. Eur Radiol 2015; 26:1538-46. [DOI: 10.1007/s00330-015-4029-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 08/04/2015] [Accepted: 09/14/2015] [Indexed: 01/15/2023]
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Tang ER, Schreiner AM, Pua BB. Advances in lung adenocarcinoma classification: a summary of the new international multidisciplinary classification system (IASLC/ATS/ERS). J Thorac Dis 2014; 6:S489-501. [PMID: 25349701 DOI: 10.3978/j.issn.2072-1439.2014.09.12] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 08/26/2014] [Indexed: 11/14/2022]
Abstract
Due to advances in the understanding of lung adenocarcinoma since the advent of its 2004 World Health System classification, an international multidisciplinary panel [sponsored by the International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS), and European Respiratory Society (ERS)] has recently updated the classification system for lung adenocarcinoma, the most common histologic type of lung cancer. Here, we summarize and highlight the new criteria and terminology, certain aspects of its clinical relevance and its potential treatment impact, and future avenues of research related to the new system.
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Affiliation(s)
- Elizabeth R Tang
- 1 Department of Radiology, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA ; 2 Department of Pathology, 3 Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Andrew M Schreiner
- 1 Department of Radiology, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA ; 2 Department of Pathology, 3 Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Bradley B Pua
- 1 Department of Radiology, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA ; 2 Department of Pathology, 3 Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
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Tsutani Y, Murakami S, Miyata Y, Nakayama H, Yoshimura M, Okada M. Prediction of lymph node status in clinical stage IA squamous cell carcinoma of the lung. Eur J Cardiothorac Surg 2014; 47:1022-6. [DOI: 10.1093/ejcts/ezu363] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 08/15/2014] [Indexed: 11/14/2022] Open
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Sasada S, Miyata Y, Tsubokawa N, Mimae T, Yoshiya T, Okada M. Role of Positron Emission Tomography/Computed Tomography Findings for Adjuvant Chemotherapy Indications in Stage T1b-2aN0M0 Lung Adenocarcinoma. Ann Thorac Surg 2014; 98:417-22. [DOI: 10.1016/j.athoracsur.2014.04.080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 04/15/2014] [Accepted: 04/15/2014] [Indexed: 10/25/2022]
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Shigematsu H, Kadoya T, Masumoto N, Matsuura K, Emi A, Kajitani K, Amioka A, Okada M. Role of FDG-PET/CT in prediction of underestimation of invasive breast cancer in cases of ductal carcinoma in situ diagnosed at needle biopsy. Clin Breast Cancer 2014; 14:358-64. [PMID: 24962555 DOI: 10.1016/j.clbc.2014.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/28/2014] [Accepted: 04/23/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the significance of FDG-PET/CT for predicting the underestimation of invasive breast cancer in cases of DCIS at needle biopsy. PATIENTS AND METHODS Of 83 consecutive cases with diagnoses of DCIS at primary needle biopsy who underwent curative surgery between 2010 and 2013, the association between the SUVmax on FDG-PET/CT before excision and the underestimation of invasive breast cancer was examined. RESULTS There were 29 (34.9%) cases diagnosed to have invasive breast cancer at excision. Receiver operating characteristics curve analysis showed the cutoff value of the SUVmax to predict underestimation of invasive breast cancer was 1.6. The rates of underestimation were 61.5% for patients with a tumor of SUVmax > 1.6 and 11.4% for patients with a tumor of SUVmax ≤ 1.6 (P < .001). A high value of SUVmax was significantly associated with symptomatic presentation (P < .001), palpability (P < .001), mass formation (P = .013), high Breast Imaging Reporting and Data System category (P = .011), and core needle biopsy (P = .007). In multivariate analysis, high SUVmax was only a significant predictive factor of underestimation of invasive breast cancer (hazard ratio, 11.7; 95% confidence interval, 3.70-37.0; P < .001). CONCLUSION SUVmax on FDG-PET/CT is useful for predicting the underestimation of invasive breast cancer in cases of DCIS at needle biopsy.
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Affiliation(s)
- Hideo Shigematsu
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Takayuki Kadoya
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Norio Masumoto
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Kazuo Matsuura
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Akiko Emi
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Keiko Kajitani
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Ai Amioka
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
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Okada M, Mimae T, Tsutani Y, Nakayama H, Okumura S, Yoshimura M, Miyata Y. Segmentectomy versus lobectomy for clinical stage IA lung adenocarcinoma. Ann Cardiothorac Surg 2014; 3:153-9. [PMID: 24790838 DOI: 10.3978/j.issn.2225-319x.2014.02.10] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 01/22/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Despite the increasing prevalence of the early discovery of small-sized non-small cell lung cancers (NSCLCs), particularly adenocarcinoma, sublobar resection has not yet gained acceptance for patients who can tolerate lobectomy. METHODS We compared the outcomes of segmentectomy (n=155) and lobectomy (n=479) in 634 consecutive patients with clinical stage IA lung adenocarcinoma and in propensity score-matched pairs. Those who had undergone wedge resection were excluded. RESULTS The 30-day postoperative mortality rate in this population was zero. Patients with large or right-sided tumors, high maximum standardized uptake value (SUVmax), pathologically invasive tumors (with lymphatic, vascular, or pleural invasion), and lymph node metastasis underwent lobectomy significantly more often. Three-year recurrence-free survival (RFS) was significantly higher after segmentectomy compared to lobectomy (92.7% vs. 86.9%, P=0.0394), whereas three-year overall survival (OS) did not significantly differ (95.7% vs. 94.1%, P=0.162). Multivariate analyses of RFS and OS revealed age and SUVmax as significant independent prognostic factors, whereas gender, tumor size and procedure (segmentectomy vs. lobectomy) were not. In 100 propensity score-matched pairs with variables adjusted for age, gender, tumor size, SUVmax, tumor location, the three-year RFS (90.2% vs. 91.5%) and OS (94.8% vs. 93.3%) after segmentectomy and lobectomy respectively were comparable. CONCLUSIONS Segmentectomy with reference to SUVmax should be considered as an alternative for clinical stage IA adenocarcinoma, even for low-risk patients.
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Affiliation(s)
- Morihito Okada
- 1 Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan ; 2 Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan ; 3 Department of Thoracic Surgery, Cancer Institute Hospital, Tokyo, Japan ; 4 Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Takahiro Mimae
- 1 Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan ; 2 Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan ; 3 Department of Thoracic Surgery, Cancer Institute Hospital, Tokyo, Japan ; 4 Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Yasuhiro Tsutani
- 1 Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan ; 2 Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan ; 3 Department of Thoracic Surgery, Cancer Institute Hospital, Tokyo, Japan ; 4 Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Haruhiko Nakayama
- 1 Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan ; 2 Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan ; 3 Department of Thoracic Surgery, Cancer Institute Hospital, Tokyo, Japan ; 4 Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Sakae Okumura
- 1 Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan ; 2 Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan ; 3 Department of Thoracic Surgery, Cancer Institute Hospital, Tokyo, Japan ; 4 Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Masahiro Yoshimura
- 1 Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan ; 2 Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan ; 3 Department of Thoracic Surgery, Cancer Institute Hospital, Tokyo, Japan ; 4 Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Yoshihiro Miyata
- 1 Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan ; 2 Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan ; 3 Department of Thoracic Surgery, Cancer Institute Hospital, Tokyo, Japan ; 4 Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Japan
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Tsutani Y, Miyata Y, Nakayama H, Okumura S, Adachi S, Yoshimura M, Okada M. Sublobar Resection for Lung Adenocarcinoma Meeting Node-Negative Criteria on Preoperative Imaging. Ann Thorac Surg 2014; 97:1701-7. [DOI: 10.1016/j.athoracsur.2014.02.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 02/05/2014] [Accepted: 02/11/2014] [Indexed: 10/25/2022]
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Tsutani Y, Miyata Y, Nakayama H, Okumura S, Adachi S, Yoshimura M, Okada M. Segmentectomy for clinical stage IA lung adenocarcinoma showing solid dominance on radiology. Eur J Cardiothorac Surg 2014; 46:637-42. [PMID: 24477740 DOI: 10.1093/ejcts/ezt645] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aimed to compare prognosis after segmentectomy and after lobectomy for radiologically determined solid-dominant clinical stage IA lung adenocarcinoma. METHODS From a multicentre database of 610 consecutive patients with clinical stage IA lung adenocarcinoma who underwent complete resection after preoperative high-resolution computed tomography (HRCT) and F-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), 327 patients with a radiologically determined solid-dominant tumour (solid component on HRCT ≥50%) who underwent lobectomy (n = 286) or segmentectomy (n = 41) were included. RESULTS No significant difference existed in recurrence-free survival (RFS) between the lobectomy and segmentectomy groups (3-year RFS, 84.4 vs 84.8%, respectively; P = 0.69). There was no significant difference in recurrence pattern between these two groups (local, 5.6 vs 7.3%, P = 0.72; distant, 9.1 vs 4.9%, P = 0.55, respectively). Even in patients with pure solid tumours, no significant difference was observed in RFS between lobectomy and segmentectomy groups (3-year RFS, 76.8 vs 84.7%, respectively; P = 0.48), as well as in those with a mixed ground-glass opacity tumour (3-year RFS, 91.0 vs 85.0%, respectively; P = 0.60). Multivariate Cox analysis demonstrated that solid tumour size on HRCT (P = 0.048) and maximum standardized uptake value (SUVmax) on FDG-PET/CT (P < 0.001), not the surgical procedure (P = 0.40), were independent prognostic factors for RFS. CONCLUSIONS RFS depends on solid tumour size on HRCT and SUVmax on FDG-PET/CT, rather than on the surgical procedure, in patients with radiologically detected solid-dominant clinical stage IA lung adenocarcinoma. Patient prognosis is similar after lobectomy and after segmentectomy for solid-dominant tumour.
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Affiliation(s)
- Yasuhiro Tsutani
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Yoshihiro Miyata
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Haruhiko Nakayama
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Sakae Okumura
- Department of Thoracic Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - Shuji Adachi
- Department of Radiology, Hyogo Cancer Center, Akashi, Japan
| | | | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
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Tsutani Y, Miyata Y, Nakayama H, Okumura S, Adachi S, Yoshimura M, Okada M. Appropriate Sublobar Resection Choice for Ground Glass Opacity-Dominant Clinical Stage IA Lung Adenocarcinoma. Chest 2014; 145:66-71. [DOI: 10.1378/chest.13-1094] [Citation(s) in RCA: 224] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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